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To be presented at 13th annual society for research on nicotine & tobacco, austin, Texas, february, 2007

Stages of Change for Smoking Cessation Over Time in a Statewide Survey of Adults

Janine Delahanty, Ph.D., Carlo C. DiClemente, Ph.D. & Robert Fiedler, J.D.

Cigarette smoking is the leading preventable cause of morbidity and mortality in the United States.  Abstinence and cessation rates do not include smoking-related attitudes and intentions, thus the Transtheoretical Model’s Stages of Change may provide a more sensitive assessment of the progression of smoking cessation.  Data derived from the 2000 and 2002 Maryland Adult Tobacco Surveys (MATS) were used to classify adults into one of the 5 Stages of Change:  Precontemplation (PC), Contemplation (C), Preparation (P), Action (A) and Maintenance (M).  The purpose of this study was to examine the distributions of the Stages for current smokers at both the Statewide and Countywide levels.  As found in the extant literature on the Stages of Change, stage status differentiated current smokers on smoking-related variables.  The 3 groups (PC, C and P) differed significantly on the average number of cigarettes smoked per day, the average number of years of smoking and an individuals’ “readiness” to quit smoking (all p’s < .001).  Statewide analysis of the stages for smoking cessation revealed that although the percentage of smokers in the population is decreasing over time, the majority of current smokers (56% in 2000 and 53% in 2002) were not considering quitting in the next 6 months.  Almost a quarter of the current smokers (23% and 24%, respectively) were seriously thinking about quitting but only about one fifth of the current smokers in 2000 (21%) and almost one-quarter (24% in 2002) were planning and preparing to quit.  Examination of Stage Status by County of Residence revealed that the Stages of Change for smoking cessation were not equally distributed among the counties.  Most counties decreased rates of smoking over time.  Two-thirds of the counties showed decreases in % of people in PC over time, suggesting more openness to considering quitting smoking and possibly successful cessation activities and campaigns.  Identifying where current smokers are in the process of smoking cessation has direct and clear implications for targeting cessation efforts and evaluation of outcomes, particularly at the county level.